1861481715 NPI number — DR. CHARLES H WEEBER III MD

Table of content: DR. CHARLES H WEEBER III MD (NPI 1861481715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861481715 NPI number — DR. CHARLES H WEEBER III MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEEBER
Provider First Name:
CHARLES
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861481715
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8019
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01102-8000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-431-4077
Provider Business Mailing Address Fax Number:
413-774-7448

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31 HALL DR
Provider Second Line Business Practice Location Address:
AMHERST MEDICAL CENTER
Provider Business Practice Location Address City Name:
AMHERST
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01002-2751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-256-8561
Provider Business Practice Location Address Fax Number:
413-256-4421
Provider Enumeration Date:
10/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  30247 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: H15014 . This is a "BLUE CROSS BLUE SHIELD-MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2357592 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 24210 . This is a "HEALTH NEW ENGLAND" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1294774 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0191582 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 030247-7879 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: C57084 . This is a "HARVARD PILGRIM HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000008368 . This is a "BMC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 102778 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2155349 04 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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